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Health Corner
Now medisave covers Cervarix Cervical Cancer Vaccination for ladies age 9 to 26! Email wellness@ahppl.com.sg for more info today!
+   TOP CANCERS AFFECTING MEN
 
   1) Colon Cancer – Colon cancer is the most common cancer affecting men and women in Singapore. It is usually more common after 45 years of age.

Risk factors include personal medical history of inflammatory bowel disease eg Ulcerative colitis, Crohn’s disease, colon polyp, colon cancer as well as family history of colon cancer, familial adenomatous polyposis, and hereditary non polyposis colorectal cancer. Other risk factors include diabetes, obesity, sedentary lifestyle, high fat low fibre diet, alcohol and smoking.

Symptoms include blood in stools, change in bowel habits, feeling of incomplete defecation, persistent abdominal discomfort, loss of appetite and weight.

Screening tests include Stool Occult blood test (checks for blood in stools that cannot be seen using naked eyes), Blood test for CEA (colon cancer marker). CT Colonoscopy also known as virtual colonoscopy, is a non-invasive procedure that uses low dose radiation CT scan to image the intestines to look for any colon polyps or colon cancer. Colonoscopy is a day surgery procedure whereby a long flexible fibre optic tube is inserted from anus into the entire colon. If there are any polyps or suspicious areas, biopsy will be done at the same setting.

Prevention – lifestyle modification with healthy diet, regular exercise, avoidance of smoking and alcohol and weight reduction (if obese).


2) Lung Cancer – Lung cancer is usually more common after 40 years old.

Risk factors include smoking. Smoking causes lung cancer and the risk is dose dependent and increases with the number of cigarettes smoked per day and number of years of smoking. On average, the risk of lung cancer in smokers is about 20 times that of non-smokers. This includes exposure to second hand smoke. Other risk factors include exposure to workplace chemicals eg arsenic, asbestos, cadmium, chromium, coal gas, nickel, vinyl chloride as well as family history of lung cancer.

Symptoms include persistent cough, chest pain, breathlessness, blood in sputum, hoarseness of voice, weight loss.

Screening tests include Chest XR, Low dose radiation CT scan of Lungs (to reveal small lesions in lungs that cannot be visualized with chest xray).

Prevention – avoid smoking, second hand smoke and toxic chemicals. Eat a diet full of fruits and vegetables.


3) Prostate Cancer – Prostate cancer usually occurs after 50 years of age, but is more common after 70 years old.

Risk factors include age, obesity and family history of prostate and breast cancer.

Symptoms include urination problems eg slow urination, weak stream of urination, blood in semen, erectile dysfunction, and bone pain in advanced stages. Early stages are typically asymptomatic.

Screening tests include digital rectal examination, Blood test for PSA (prostate cancer marker), Ultrasound prostate.

Prevention – Maintain healthy weight and adopt healthy lifestyle.


4) Liver Cancer – Liver cancer is more commonly seen in Asians. It usually affects those above 40 years of age. But it can occur earlier in people with Hepatitis B or C.

Risk factors include Hepatitis B, Hepatitis C, Liver cirrhosis, Alcoholic liver disease and aflatoxin (poison arising from fungus growing in badly preserved foods). The risk of liver cancer in a Hepatitis B or C carrier is about 100 times higher compared to a non-infected person.

Symptoms include abdominal discomfort, abdominal swelling, nausea, vomiting, jaundice, loss of weight and appetite.

Screening tests include Blood test for AFP (liver cancer marker), Ultrasound Liver (checks for liver lesions and fatty liver), Fibroscan (checks for liver hardening), CT or MRI scan Liver.

Prevention – Hepatitis B vaccination, lifestyle modifications including avoidance of alcohol consumption and maintenance of healthy weight, avoidance of unprotected sexual intercourse, multiple sexual partners and intravenous drug abuse.


5) Lymphoma – Lymphoma is a cancer of lymphatic system. It can be seen in children, young adults as well as those above 50 years of age.

Risk factors include infection with viruses that lower immune system eg HIV, medications that suppress immune system, Helicobacter pylori and EBV.

Symptoms include painless swollen lymph nodes of neck, arm pit, groin, persistent fever, night sweats, and weight loss.

Screening tests include biopsy of lymph node.

Prevention – healthy lifestyle.


6) Skin Cancer – Skin cancer is divided into melanoma and non-melanoma skin cancer eg basal cell carcinoma and squamous cell carcinoma. In Singapore, basal cell carcinoma is the most common, followed by squamous cell carcinoma. But melanoma is the most dangerous due to its ability to spread early.

Risk factors include fair skin, prolonged sun exposure, personal medical history of moles, precancerous skin lesions or skin cancer, exposure to radiation eg radiation treatment for eczema, weakened immune system and family history of skin cancer.

Symptoms include skin lesions – Asymmetry, Border (irregular, uneven), Color (haphazard, color changes), Diameter (>6mm), Evolving (enlargement).

Screening tests include Skin biopsy.

Prevention – avoid sun and ultraviolet radiation exposure, use of sun protection devices.


7) Stomach Cancer – Stomach cancer is more common in men and people above 50 years of age.

Risk factors include personal medical history of Helicobacter pylori infection, stomach polyps, long term stomach inflammation (chronic atrophic gastritis and intestinal metaplasia), smoking, diet rich in salty and smoked foods, low consumption of fruits and vegetables, and family history of stomach cancer.

Symptoms include abdominal discomfort, bloatedness, indigestion, heartburn, nausea, vomiting, loss of appetite and weight, fatigue due to anaemia resulting from blood loss.

Screening tests include blood test for full blood count (checks for anaemia) and Helicobacter pylori, Urea breath test (checks for current Helicobacter pylori infection), Barium meal (XR with ingestion of barium) and Gastroscopy (day surgery procedure whereby a thin fibre optic tube is inserted from throat into the stomach – biopsy can be done if there are suspicious areas).

Prevention – eat more fruits and vegetables and less salty and smoked foods, avoid smoking and eradicate Helicobacter pylori infection with medications.


8) Nose Cancer – Nose cancer affects men more than women and is more common in age group 35 – 55 years of age. It is more frequently seen among Chinese.

Risk factors include male gender, race (Chinese), EBV infection, diet rich in salt cured foods and family history of nose cancer.

Symptoms include painless neck lump, nose blockage, nose bleed, decreased hearing, ringing in ears, unusual facial pain or numbness, double vision, headache.

Screening tests include blood test for EBV and Nasoendoscopy (office procedure whereby a thin, flexible tube is inserted via the nostril to the back of nose to check for lumps) and Biopsy of cervical lymph node.

Prevention – eat more fruits and vegetables and less salty and smoked foods, avoid smoking.


9) Kidney Cancer – Kidney cancer is slightly more common in men than women.

Risk factors include obesity, personal medical history of hypertension and certain inherited syndromes, smoking and family history of kidney cancer.

Symptoms include blood in urine, persistent abdominal or back pain, persistent fever, weight loss.

Screening tests include urine test for blood and Ultrasound/ CT kidneys.

Prevention – maintain a healthy weight, control high blood pressure and avoid smoking.


10) Pancreas Cancer – Pancreatic cancer is more common above 50 years of age.

Risk factors include smoking, obesity, genetic syndrome eg neurofibromatosis type 1, Multiple endocrine neoplasia type 1 and family history of pancreatic cancer.

Symptoms include abdominal discomfort, bloatedness, jaundice and weight loss.

Screening tests include blood test for CA 19-9 (pancreas cancer marker) and Ultrasound Abdomen/ CT or MRI Pancreas and ERCP( a fibre optic scope is inserted down the throat into the stomach and small intestine where the ducts of the pancreas drain into, dye is then injected into the ducts, xr taken and biopsy can be done) .

Prevention – eat more fruits and vegetables, maintain a healthy weight and avoid smoking.

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+   VACCINES FOR ADULTS ABOVE 50 YEARS OLD
 
   With age, our body changes and our immune system begins to lose some of its function and cannot respond as quickly and efficiently to stimuli. This puts us at higher risk of diseases as we age. The severity of the diseases is also greater.

Vaccines can help to boost the immune system to lower the chance of one getting a vaccine-preventable disease.

Highly recommended vaccines

1) Pneumococcal Vaccine – Prevnar Pneumococcal 13-valent conjugate vaccine (PCV13), Pneumovax 23-valent polysaccharide vaccine (PPSV23).

Pneumococcal disease is caused by the bacteria Streptococcus pneumonia which is transmitted though physical contact or droplet. It causes sudden onset of fever, cough, chest pain, breathlessness. It can cause pneumonia and invasive pneumococcal disease – bacteremia and meningitis (brain infection). The disease is most common in young children; the elderly as well as those with chronic diseases eg heart disease, diabetes and poor immune system.

Adults more than 50 years of age can consider doing PCV13 first followed by PPSV23 about 2 months later. PPSV23 can be covered by medisave for adults above 65 years of age as well as those under 65 years of age with certain medical conditions.

2) Diphtheria, Pertussis (Whooping cough), Tetanus (Lockjaw) Vaccine – Boostrix

Diphtheria is an infection caused by Corynebacterium diphtheria bacteria which is transmitted through physical contact and droplet. It causes fever, sore throat, swollen glands and pseudomembrane at the nasal passage and throat with difficulty breathing. It can lead to severe heart muscle inflammation and nerve damage.

Pertussis, a respiratory illness commonly known as whooping cough, is a very contagious disease caused by a type of bacteria called Bordetella pertussis. It is transmitted through contact and droplet. The disease usually starts with cold like symptoms, followed by violent, rapid coughs for up to 10 weeks. It can also lead to ear infection and pneumonia.

Tetanus is an infection caused by bacteria called Clostridium tetani. The bacteria is present everywhere in the environment, including soil, dust and manure. It can get into the body through broken skin, usually through injuries from contaminated objects. Symptoms include fever, headache, jaw cramp, muscle stiffness and spasm, seizures and complications include breathing difficulty, pneumonia, pulmonary embolism.

The vaccine (Boostrix) is recommended once in 10 years.

3) Influenza Vaccine

Influenza (flu) is a contagious respiratory illness caused by influenza viruses – transmitted through physical contact and droplet. It can cause mild symptoms such as fever, cough, running nose, sore throat, fatigue. It can also lead to severe illness such as pneumonia, bronchitis, sinus and ear infection. Serious outcomes of flu infection can result in hospitalization or death. Some people, such as young children, elderly and those with chronic medical problems are at high risk for serious flu complications.

The vaccine is recommended yearly because flu viruses are constantly changing and the flu vaccine is updated annually to keep up with the change in the flu viruses.

4) Zoster Vaccine – Zostavax

According to the CDC, 1 in 3 people will experience zoster (shingles) in their lifetime. 70% occurs in people above 50 years of age. This occurs due to reactivation of the varicella virus (chicken pox). It can lead to painful blister like rashes, post-herpetic neuralgia, brain infection (encephalitis), blindness, hearing problem and pneumonia.

1 dose of zostavax is able to reduce the incidence of zoster by 70%.
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+   Sexually Transmitted Diseases
    Sexually transmitted diseases (STD) refer to infections that are transmitted through sexual intercourse. It can strike anyone, regardless of age, gender, race, sexual tendency, marital status and type of sex (oral, anal or vaginal sex) and the consequences may last a lifetime. Although condom is highly effective in reducing risk of contracting a sexually transmitted disease, it may not be 100% foolproof. Many STDs are silent – they cause no symptoms in the initial stage, especially in women. Even if a person is asymptomatic, the disease can still be transmitted to the sex partner.

Long term consequences for women include pelvic inflammatory disease, infertility, ectopic pregnancy and cervical cancer. It may also lead to irreversible damage to babies infected by their mothers during gestation or birth, including blindness and mental retardation. For men, the long term consequences include sterility and cancer of penis and anus.

HPV
Human Papilloma Virus (HPV) is the most common sexually transmitted disease. There are many subtypes of HPV that can infect the genital areas of both men and women. Even the mouth and throat can also be infected. Most people who are infected do not know that they have it as they do not have any symptoms. It is transmitted through genital and skin contact.

Complications
1) Cervical Cancer – High risk oncogenic strains of HPV such as HPV 16 & 18 are responsible for at least 80% of cervical cancer cases.

2) Other types of cancer – Vulvar cancer, Vaginal cancer, Penile cancer, Anal cancer, mouth and throat cancer.

3) Genital warts – this presents as bumps in the genital area, within weeks or months after sexual contact. This is usually caused by HPV strains 6 & 11.

Investigation – HPV DNA test together with PAP smear for females

Treatment – There is no treatment for the virus itself. Treatment is available for warts and cancer. For warts, podofilox, imiquimod, cryotherapy using liquid nitrogen, surgical removal can be considered.

Prevention – HPV vaccines – Cervarix and Gardasil are highly recommended from age of 9 years old.

Chlamydia
This is caused by the bacteria Chlamydia trachomatis which can damage the female reproductive organs. It can be transmitted through oral, vaginal and anal sex and from mother to baby during childbirth.

Majority of patients have no symptoms. Symptoms may occur within 1 to 3 weeks. Women – abnormal vaginal discharge, burning sensation during urination, pain during intercourse, lower abdominal pain, bleeding between menstrual periods, fever. Men – penile discharge, pain during urination, itch of penis.

Complications – chronic pelvic pain, pelvic inflammatory disease, fallopian tube infection, ectopic pregnancy, infertility, epididymitis, Reiter’s syndrome

Investigation – urine, cells from penis / cervix for Chlamydia DNA PCR test

Treatment – Antibiotics eg doxycycline, azithromycin

Gonorrhea
Gonorrhea is caused by Neisseria gonorrhoeae bacterium. It can infect the mucous membranes of the female reproductive tract, the urethra and the mouth, throat, eyes and anus. It can be transmitted through sexual contact (no ejaculation required) with mouth, vagina, penis, and anus and from mother to child during childbirth.

Many do not have symptoms. Symptoms may occur within 1 to 14 days.
Women – painful urination, foul smelling vaginal discharge, abnormal vaginal bleeding, lower abdominal pain.
Men – painful urination, white/yellow/green urethral discharge, scrotal pain

Complications – pelvic inflammatory disease, ectopic pregnancy, epididymitis, infertility, disseminated gonococcal infection.

Investigation – urine, urethral, endocervical, vaginal specimen for Gonorrhea DNA PCR test

Treatment – Antibiotics – combination therapy using intramuscular ceftriaxone and oral azithromycin or doxycycline

Genital Herpes
This is caused by Herpes Simplex Virus – Type 1 or Type 2. HSV Type 1 usually causes cold sores, but sometimes may cause genital herpes. HSV Type 2 is the usual cause of genital herpes. The virus is spread by direct physical contact.

Incubation period ranges from 2 days to 2 weeks. Some people do not have symptoms. Others get blisters on or around the genitals, anus or mouth. The blisters break and leave painful sores that may take up to 1 month to heal. Once infected, the virus hides in neurons in the body indefinitely and gets reactivated in times of triggers such as stress and hormonal changes.

Complications – bacterial and fungal superinfections such as balanitis, eye infections, corneal ulcers, blindness, skin infections, brain infections (encephalitis and meningitis), disseminated herpes, neonatal herpes (baby).

Investigation – blood test for HSV Type 1 and 2 antibodies, HSV culture and PCR test for viral DNA or RNA.

Treatment – There is no cure for herpes. Antiviral medications can prevent or shorten outbreaks.

Syphilis
This is caused by the bacterium Treponema Pallidum. It is transmitted through direct contact with syphilitic sore, chancre. Chancres can occur at the external genitalia, vagina, anus and mouth. Pregnant women can transmit the disease to the unborn child.

Symptoms may appear as early as 10 days or as late as 3 months after exposure. In the primary stage, there may be a single chancre (sore) or multiple sores. The sore is usually firm, round and painless. It usually lasts 3 to 6 weeks and heals regardless of treatment. If the person is not treated, it progresses to secondary stage, whereby there are rough, red, non itchy skin rashes on hands and feet and sores in mouth, vagina, and anus. There are non specific symptoms of fever, sore throat, headache, swollen lymph nodes, fatigue and weight loss. Without treatment, it will progress to latent stage with no signs or symptoms. Late stage of syphilis can occur after 10 to 20 years, with damage to multiple organs – brain, nerves, eyes, heart, blood vessels, liver, bones and joints.

Genital sores caused by syphilis make it easier to transmit and acquire HIV sexually.

Investigation – Blood test for VDRL and TPHA

Treatment – Intramuscular injection of penicillin

Chancroid
This is caused by a bacteria – Haemophilus ducreyi. It is transmitted through sexual contact. Symptoms appear within 1 day to 2 weeks. It starts with a small bump at the genitals. The bump transforms into a soft, painful, well defined ulcer with grey base that bleeds easily. Inguinal lymph nodes may be swollen.

Complications – urethral fistulas and scars

Investigation – diagnosis is clinical

Treatment – Antibiotics eg azithromycin, erythromycin, ciprofloxacin, ceftriazone

Bacterial Vaginosis
This is a common type of infection of the vagina caused by bacteria. It occurs when the normal balance of bacteria in the vagina is disrupted and replaced by overgrowth of bad bacteria. The cause is not fully understood, but it may be related to douching, smoking and having multiple sexual partners.

Symptoms include abnormal white/gray/yellow foul smelling vaginal discharge, itch around genitalia, and burning sensation during urination

Complications – increase in risk of other STDS, increase risk of miscarriage and preterm delivery during pregnancy.

Investigation – vaginal discharge for bacteria and DNA, PAP smear

Treatment – antibiotics – oral or vaginal eg metronidazole, probiotics for prevention

Trichomoniasis
This is caused by a parasite- Trichomonas vaginalis. It is transmitted through sexual contact. Only about 30% of people infected develop symptoms. Infection is more common in women. Symptoms occur within 5 days to 1 month.

Symptoms in men include itch, irritation inside penis, burning sensation after urination or ejaculation, penile discharge. For ladies, there is itch, burning sensation, redness of the genitals and vaginal discharge.

Complications – premature delivery (for pregnant women with the infection).

Investigation – urine, vaginal swab for Trichomonas PCR DNA test

Treatment – antibiotics – metronidazole for patient and partner

HIV
The Human Immunodeficiency Virus is a virus that kills the body’s CD4 cells. CD4 cells help the body fight infection and disease. AIDS (Acquired ImmunoDeficiency Syndrome) is a disease whereby HIV destroys the immune system. HIV is transmitted by blood and body fluids. It is not transmitted though sharing of food and drinks. Babies born to mothers with HIV can get infected during pregnancy, birth and breastfeeding.

HIV remains asymptomatic for years. Stages of HIV – acute retroviral syndrome (fever, fatigue), HIV without symptoms, HIV with symptoms (e.g. weight loss, pneumonia, cancer), AIDS

Complications – AIDS (late stage of HIV infections) – this usually develops within 10 to 12 years after infection. The CD4 count is very low and person succumbs to multiple infections caused by viruses, bacteria, fungi and parasites and cancers such as Kaposi sarcoma, lymphoma and cervical cancer.

Investigation – HIV antibody test (window period up to 6 months), Confirmation blood test using Western Blot

Treatment – Anti HIV drugs

Viral Hepatitis
The most common forms of viral hepatitis are A, B and C. These are viruses that affect liver.

Hepatitis A is spread through ingestion of contaminated food or drinks. Symptoms of fever, vomiting, abdominal pain, yellowing of skin, dark urine and pale stools occur within 2 to 6 weeks of exposure. It may lead to liver failure.

Hepatitis B & C are transmitted by childbirth, blood and body fluids. They are not spread through food and water. They may cause acute hepatitis (symptoms similar to hepatitis A) with 6 weeks to 3 months. Chronic infection can occur whereby the virus resides within the body – Hepatitis B / C carrier state.

Complications – Liver damage, Liver hardening, Liver cancer, Liver failure.

Investigation – Blood test for Hepatitis A, B, C

Treatment – No treatment is available for acute Hepatitis A, B, C. Chronic Hepatitis B, C carriers require lifetime surveillance with blood test, ultrasound liver & fibroscan. Medications may be considered if clinically warranted.

Prevention – Hepatitis A vaccine is advised from age 1 onwards. Hepatitis B vaccine is advised at birth / any age. Combined Hepatitis A & B vaccine is available. There is no vaccine for Hepatitis C.

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+   FAQ on HPV Vaccination (Cervical Cancer)
(2 brands: Gardasil and Cervarix)
   
Gardasil
  • Recommended for ladies above 9 years of age and men.
  • Protects against HPV types 6, 11, 16 & 18
  • Protects against Cervical cancer, pre-cancer of cervix, Vulvar cancer, Vaginal cancer, Anal cancer, Oral cancer, and Genital warts.
  • Not recommended during pregnancy.

Dosage schedule
First dose: decided by patient and doctor
Second dose: 2 months after the first dose
Third dose: 6 months after the first dose
Cervarix
  • Recommended for ladies above 10 years of age.
  • Protects against HPV types 16 & 18
  • Protects against Cervical cancer, pre cancer of cervix, Vulvar cancer, Vaginal cancer, Anal Cancer and Oral cancer.
  • Not recommended during pregnancy.

Dosage schedule
First dose: decided by patient and doctor
Second dose: 1 month after the first dose
Third dose: 6 months after the first dose

Common questions on HPV vaccination (cervical cancer)

What is the HPV vaccination for? HPV vaccination is a preventive measure to protect one from HPV, a virus that can affect many parts of the body. HPV is a family of many subtypes of virus, with some that lead to certain types of cancer, including Cervical Cancer, one of the top cancers that affect women worldwide. For example, HPV types 16 & 18 cause about 80% of cervical cancers, while HPV types 6 and 11 cause about 90% of genital warts.

Our clinic carries both vaccines that have been approved for use in Singapore- Cervarix & Gardasil.

Is HPV vaccination medisave-claimable?

As with MOH’s regulations, for HPV vaccination, ladies (Singaporeans and Singapore PRs) between the ages of 9-26 years old are eligible to claim under Medisave (from own account or family members’ account), for up to $400 per year.

Why is HPV vaccination important?

Without vaccination, it is estimated that the majority of sexually active people will catch HPV during their lifetime. Non-sexually active people can also get infected with HPV through contact- e.g. towels, underwear, skin etc. Many people who have HPV may not show any signs or symptoms. This means that they can transmit (pass on) the virus to others without knowing it.

How long will the HPV vaccine last?

From research and modeling predictions, the HPV vaccine should last about 10 to 20 years. However, it varies with individual. No booster is required at the moment.

How is the HPV vaccine given?

The HPV vaccine is given as an injection usually in the arm muscle by our certified nurse. The full course comprises of 3 doses to be administered in 6 months.

The dosage schedule depends on the vaccine brand. (pls refer above). The schedule is flexible.

How do I know if I’m suitable for the HPV vaccine? All ladies above 9 years of age and men 9-26 years of age are suitable. The vaccine works best when given before exposure to HPV and when the person has not become sexually active. Studies have shown benefits of the vaccine in age groups up to 45 years of age. You can consult our doctor to find out the appropriate vaccine for you and your child.

You are not suitable for the HPV vaccine if:

You are allergic to any of the ingredients in the vaccine (including any of the ingredients listed under inactive ingredients) or if you have an allergic reaction after receiving a dose of the vaccine. The vaccine is not recommended during pregnancy.

If I’m already sexually active, will I still benefit from the HPV vaccine?
What if I already have HPV? Will the HPV vaccine still work on me?
Can I do the vaccination if my PAP smear test is abnormal?


YES! You can still benefit from the vaccine, because even if you have been exposed to HPV, you may not have been exposed to the types of the virus covered by the vaccine. Moreover the body may not be able to mount sufficient antibodies to prevent future infections.

By doing the HPV vaccine, your body will be able to produce sufficient antibodies to prevent future HPV infections. Clinical studies have shown that women, who have been previously exposed to HPV type 16 or 18 but had cleared the infection, were subsequently protected after vaccination.

HPV vaccine does not cure HPV infection.

Are there any possible side effects of the HPV vaccine?

The vaccine is generally well tolerated with minimal side effects. The reported side effects include pain, redness, and swelling at the injection site and generalized reactions.

For any unusual or severe symptoms after receiving the vaccine, patient should contact the doctor immediately.

Is the HPV vaccine suitable for young children?

The HPV vaccine can be used in children as young as 9 years old.

Is there anything I should do or take note of before the HPV vaccination?

You should tell the doctor if you or your child:
• has had an allergic reaction to the vaccine
• has a bleeding disorder and cannot receive injections in the arm
• has any illness with a fever higher than 100°F (37.8°C) is pregnant or is planning to get pregnant
• takes or plans to take any medicines, including over- the-counter medicines
• has a weakened immune system, for example due to a genetic defect or Human Immunodeficiency Virus (HIV) infection, or if you take medicines that affect your immune system.

Can I go for other vaccines and medications after I have received the HPV vaccine?

Yes, you can do so with common vaccines such as Hepatitis A, B, DPT, polio, Flu vaccines.

What should I do if my child or I miss a dose?

The doctor will decide when to give the missed dose.

It is important that you follow the instructions of the doctor regarding return visits for the follow up doses. Usually, our nurse will give a reminder call to the patient one day before the designated date.

What other important information about the HPV vaccination should I know?

There are more than 100 HPV types: the HPV vaccine will not protect against every type.

Regular PAP smear test is still advisable for all ladies who have had sexual intercourse.
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+   FEMALE CANCERS - Womb, Ovary, Cervical and Breast Cancer
    Womb Cancer
Womb cancer usually affects ladies in age group 60 – 70 years.

Risk factors include early onset of menses, late onset of menopause, never being pregnant, obesity, tamoxifen, long duration of estrogen therapy, medical conditions such as diabetes, polycystic ovary syndrome, endometrial polyps and colon cancer as well as high fat diet.

Symptoms include abnormal menses, bleeding after menopause, abnormal vaginal discharge and persistent abdominal pain.

Screening tests include PAP smear (abnormal cells eg endometrial cells), Ultrasound Pelvis (non invasive scan of womb and ovaries with no radiation). Ultrasound pelvis can visualize the womb for the womb lining, growths of the womb eg uterine fibroids and ovary lesions such as ovary cysts and ovary cancer. Other tests include endometrial sampling (office procedure) and hysteroscopy, dilation and curettage.

Prevention – lifestyle modification with low fat diet, oral contraceptive pills.

Ovary Cancer
Ovary cancer can affect ladies of any age group.

Risk factors include personal medical history of breast, womb, colon and stomach cancer, never being pregnant, high fat diet and family history of ovary, womb, breast and colon cancer.

Symptoms include abnormal menses, abdominal pain, bloatedness, loss of weight and appetite, change in bowel and urination habits and backache.

Screening tests include pelvic exam, blood test for CA125 and Ultrasound pelvis.

Prevention – lifestyle modification with low fat diet, oral contraceptive pills.

Cervical Cancer
Cervical cancer can affect ladies of any age group ranging from as young as 18 years old til as old as 80 years old.

The main cause of cervical cancer is the Human Papilloma Virus (HPV). There are more than 100 subtypes of HPV – some non cancer causing, some cancer causing, some can cause genital warts. HPV strains 16, 18, 31 and 48 account for more than 80% of all the cervical cancer cases. This is the most common sexually transmitted disease - up to 50% of all ladies have this virus at some point in time of their lives.

This virus is transmitted by sexual intercourse, skin contact, fomites eg towels, undergarments and mother to newborn. Condoms reduce the risk of transmission but it is not 100% effective. There is no treatment available for the virus. The virus may be cleared by the body’s immune system, but the body does not develop sufficient antibodies to prevent future infections.

Risk factors include multiple sexual partners, sexual intercourse from young age, having sex with partner whose sexual history is unknown, personal history of other sexually transmitted diseases, those with weakened immune system such as diabetes and HIV, smokers, those on long term steroids and oral contraceptive pills and family history of cervical cancer.

Symptoms include abnormal menses, intermenstrual bleeding, abnormal vaginal discharge, pain during sexual intercourse, lower abdominal pain, loss of weight and appetite.

Screening tests include PAP smear, Thin Prep and HPV test. PAP smear is a painless, non invasive test whereby cells are collected from the cervix via a soft brush. It should be done at least once in 3 years. The accuracy is not 100%, hence if done yearly, the accuracy is enhanced.
Thin Prep is the most comprehensive FDA approved PAP smear test available. The cells are placed in a solution instead of being spread on a slide. The solution with the cells will be sent to the lab. The thin prep imager system increases disease detection.
HPV test is a FDA approved molecular test which screens the cervix for 14 high risk HPV types. The high risk HPV types will cause transformation of normal cells in cervix into abnormal cells. The abnormal cells will become pre-cancer cells (CIN) which will subsequently change into cervical cancer if not treated. It is highly recommended for ladies above 30 years of age and those with abnormal PAP smears. HPV test is only available for ladies.
Colposcopy is recommended if PAP smear test shows precancerous changes.

Prevention – keep to 1 sexual partner, delay age of sexual intercourse, and avoid unprotected sexual intercourse. Consider HPV vaccination for yourself and your family members for prevention of pre-cancer and cervical cancer. The vaccination is highly recommended for all men and ladies above 9 years of age. It is safe and 99% effective with no significant side effects. It is incorporated in childhood immunisation programmes world-wide. The vaccine is also recommended for ladies who are already married. Older women can also benefit from the vaccine. Protection should last at least 10 to 20 years.

Singaporeans and Singapore PRs under 27 years of age can make use of their own or family members’ Medisave for full payment of the HPV vaccine at Medisave accredited clinics.
Asia Healthpartners is a Medisave accredited clinic.

Breast Cancer
Breast cancer is the top cancer for ladies. It is more common in ladies after 40 years of age.

Risk factors include early age of menses, late age of menopause, never being pregnant, family history of breast, womb, ovary and colon cancer, defective genes (BRCA1 and BRCA2), radiation exposure to chest during childhood days, obesity, high fat diet, excessive alcohol consumption, long term conventional hormone replacement therapy with estrogen.

Symptoms include breast lump, breast pain, nipple discharge and skin changes over the breast.

Screening tests include mammogram and ultrasound breasts. Mammogram is a low dose x-ray of the breasts that can pick up very small breast cancers, breast calcifications (benign and malignant). It is recommended yearly for ladies between 40 – 50 years of age and once in 2 years for ladies above 50 years of age. Asia Healthpartners Mammogram is fitted with Mammopad Breast Cushion which makes the mammogram experience softer and more comfortable. Ultrasound breasts is a painless, non invasive, no radiation type of scan for breast lumps. It can determine if the breast lump is solid or liquid and if it looks suspicious in nature. It is recommended for any age group, especially those with lumpy breasts. MRI Breasts is recommended if mammogram and ultrasound breasts are abnormal, to give more information about the nature of the growth. Other tests will include Breast Biopsy done by needle aspiration, ultrasound guided, mammotome or open.

Prevention – lifestyle modifications including low fat diet, regular exercises reduction in alcohol intake and maintenance of healthy weight.
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+   Manage Your Health and Keep Fit
   
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+   Eating Disorders
   
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+   Premature Ejaculation and Ulthera
   
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+   Dr Chong Yeang Chern - Featured in Mind Your Body magazine 27 January 2011
   
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+   Dr Chong Yeang Chern - Featured in Men's Health magazine 14 January 2011
   
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+   Dr Chong Yeang Chern - Featured in Men's Health magazine 10 January 2011
   
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+   Dr Chong Yeang Chern - Featured in Men's Health magazine October 2010
   
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+   Dr Chong Yeang Chern - Featured in Men's Health magazine September 2010
   
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+   Dr Chong Yeang Chern - Featured in Men's Health magazine August 2010
   
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+   Male menopause – Myth or Fact?
    Men and women are not alike. Most of us are aware of this fact. When a woman goes through menopause, she experiences a variety of physical and emotional changes. The truth is that, men also go through a change very much like women in the middle years. Hence the term – 'mid life crisis' is derived.

Of course, every one of us is different. Not everyone will experience turbulence in the middle years. Sometimes it may be difficult to differentiate the symptoms of such changes from symptoms due to other diseases.

Male menopause, also known as andropause, generally occurs from around 40 years of age. This happens as a result of decline in hormones such as male sex hormone – testosterone. Compared to women, the decline is more gradual, hence the changes may be more subtle. As a result, a lot of men attribute the changes to normal ageing.

Testosterone is the most important male sex hormone. It is essential for maintaining health as well as quality of life. It is produced mainly in the testes. Testosterone declines with age due to death of testes cells and decreased stimulation by the brain.

As a result of reduced levels of testosterone, a multitude of symptoms can occur in the male body.
1. Feel tired
2. Tend to fall asleep after meals
3. Anxious, irritable, depressed
4. Poor sense of well being, decreased enjoyment of life
5. Increased sweating
6. Problem with sleep
7. Decrease in muscular strength, endurance, sports ability
8. Decrease in work performance
9. Bodyache
10. Increase in weight, especially around the waist
11. Decrease in sexual desire/ libido
12. Decrease in morning erections
13. Erection is less strong
If a man in such a situation ignores the problem, he may be at greater risk of heart disease as well as osteoporosis.

How does one confirm the condition?
If you do have some of the symptoms listed above, a blood test for testosterone, sex hormone binding globulin (protein that binds to testosterone), other hormones such as DHEA(S) and growth hormone is advised.

Tips to cope with the change -
1. Healthy diet
2. Regular exercise
3. Adequate sleep
4. Stress reduction techniques
5. Sufficient fluids
6. Less alcohol and caffeine
7. Good social support

Treatment
Testosterone replacement therapy must always be administered by trained physicians. Regular follow-up including blood test for testosterone, prostate cancer marker and blood counts is required.

Testosterone is available in different forms – oral tablet, topical cream and injection. Oral tablet does not provide steady blood levels – hence not generally recommended. The cream form makes use of bio-identical testosterone and the preparation is custom made in doses suitable to patient’s needs and condition. The cream is applied daily in the morning to the inner arms / thighs. As for the injection form, it provides convenience to the patient as it requires only 4 injections per year. The testosterone level with the injection method is more consistent.

DHEA therapy is administered orally. This is an adrenal gland hormone. Low levels may lead to fatigue and low sex drive.

Growth hormone therapy is administered by own self via injection – fine needle or needleless method on daily basis. This is a brain hormone. Decline may contribute to memory and sleep problems, increase in weight, decrease in muscle bulk, poorer hair and skin.

In my clinic practice, I encounter many men in mid 40s with the problem of andropause. A lot of them were not aware of such a condition previously due to lack of publicity. For those who are on the treatment programme, they are happy with the outcome as the treatment has ‘renewed’ their life. As one patient has said – I feel like a different person altogether! I have become stronger in sports and I have lost weight too.

In conclusion, early diagnosis and treatment is the way to go to improve your health and vitality!
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+   Dr Chong Yeang Chern - Featured in Men's Health magazine June 2010
   
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+   Dr Chong Yeang Chern - Featured in Men's Health magazine May 2010
   
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+   Looking into the Brain – Connecting Body & Mental Health
    The mind speaks a thousand words. Our state of mind can relate to the status of our health. In the current economic situation, we are bombarded with bad news from multiple sources. Financial issues, work stress, family problems will lead to a cumulative impact on our mind. The stress and frustration that one faces, if poorly managed, can lead to a cascade of health issues. The classic scenario is that of a tired, nervous person with pain at different parts of the body and suffers from indigestion, poor appetite and sleepless nights.

It is therefore essential to manage stress well to maintain good physical and mental fitness in order to fight the challenges of life. Stress can have a negative impact on health as it may weaken the immune system, making us more susceptible to diseases.

Stress management involves recognizing and acknowledging that one is under stress, looking for the sources of stress and learning healthy ways to overcome stress. Time management, prioritization and positive thinking are important techniques. Living a healthy lifestyle and having a strong social support network are equally as crucial.

It is never too late to make the first step to overcome stress and reverse the damage.

Here are some great tips:

For The Mind -
1. Practice slow deep breathing in between work – this will allow your mind to relax and recharge
2. Listen to soft smoothing music
3. Talk to a friend/colleague – vent out your frustrations
4. Pen down your thoughts and things that bother you
5. Indulge in something enjoyable, take up a new hobby
6. Laughter is the best medicine. Look for humor in life.

For The Body -
1. Start a regular exercise regime - 3 times a week, 30 minutes for each session. Walk whenever there
are opportunities
2. Increase your intake of vegetables and fruits
3. Consider supplements such as anti-oxidants
4. Pamper yourself with a massage to release muscle tension and relax the mind

Kick-starting the routine may seem hard at first but as it develops into a habit, it would be a breeze. Remember to assess the overall progress. Seek professional input and guidance. Health screening is also useful as a guide to assess for any medical problems and complications as a result of stress.

Economical comprehensive health screening packages which include anti-stress massages are now available at Asia HealthPartners.
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+   Sports – The double edged sword
    People who exercise may lower their risk of diseases but only those who are aware of the possible risks of strenuous sports and be prudent about it will reap the full benefits of physical activities.

In Singapore, there is an increasing trend of mortality- marathon related sudden death cases over the past few years, with the latest headlines of a 17 year old death in a triathlon and a 25 year old death in a 21km run. Even so, the number of participants for the competitions did not seem to decrease but continue to soar with popularity.

Do the participants fully understand the risk they have put themselves through?

A recent study in Orlando cited that the risk of sudden death in participants of triathlons is at least twice that of marathons. Statistics showed that there are 15 deaths per million participants of triathlons compared to 4-8 deaths per million participants of marathons. It was concluded that the main risk is due to heart failure during the swimming part. Autopsies revealed that 60% of the death was due to underlying problems.

"When we exercise, the heart is made to pump harder to ensure sufficient oxygen and nutrients reach the heart muscles. Contacting an external lower temperature such as cold water will constrict vessels resulting in the heart having to pump even harder to push the blood through," explained Dr. Chong Yeang Chern, Wellness Physician at Asia HealthPartners. “In whichever case, over-stressing the heart may aggravate pre-existing problems and increase mortality risk. Hence a pre-race checkup is important to screen for pre-existing medical conditions and should not be overlooked."

This is supported by the Triathlon Association of Singapore which encourages participants to have a thorough medical check up before any race.

When carefully manipulated, physical exercises can lower the risk of heart diseases, hypertension, diabetes, high cholesterol, and osteoporosis; reduce stress and keep the body looking fit!

Here are some advices from Dr Chong to lower athlete’s health risk:

Have regular health screening. Ensure that your medical screening includes Treadmill Stress Test to
check that the heart is fit for the physical stress of exercise and does not have underlying problems such as heart artery diseases.
Self-check assessment: Measure your own heart rate during peak exercise and look out for any chest
discomfort or difficulty breathing. Maximum heart rate should not exceed (220 – age)/ minute. Recommended heart rate to achieve is 60-80% of the maximum heart rate.
Be well-trained and conditioned for any types of physical competition. Check with your trainer or
professional pertaining to the risk of activities if unsure, especially for any physical challenges.
Eat right. Seek a professional or a dietician’s advice at least months before any competition.

Remember – Staying fit is a challenge. So be sure to take good care of your health!
Prevention pays in the long run!
Live Well. Live Happy.

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+   Uncontrollable Weight Gain
- A repercussion of hormone deficiency
    If you have been experiencing weight gain despite cutting down on daily food intake portion, choosing food wisely and exercising regularly, you may have medical conditions that contribute to the weight gain such as hormone deficiencies and food intolerance.

Hormone deficiencies will have an impact on the quality of life. Symptoms such as sleepless nights, body ache, dry skin, thin hair, fatigue, poor concentration, poor physical stamina, low sex drive as well as weight gain may creep in. Unfortunately many people attribute it to part and parcel of the ageing process and live with it without realizing that medical options are available for treatment as well as prevention. In the long run, the hormone deficiencies can lead to serious health consequences such as heart diseases and osteoporosis.

Determine your Health Status
Before concluding that the above symptoms are due to hormone deficiencies, one should have a thorough check done.

Health Screening can detect silent pre-existing medical conditions and prevent deterioration of the existing problems, thereby reducing healthcare costs incurred due to serious conditions. An affordable yet comprehensive screening can be done with a simple blood test checking on hormones such as male hormone (testosterone), female hormones (estrogen and progesterone), brain hormone (growth hormone), thyroid hormones and adrenal hormone (DHEAs). It is always advisable to consult the doctor prior to the screening so that appropriate tests can be done as each and every one of us is different in our genetic makeup and lifestyle habits.

Know the options & keep an open mind
Based on in-depth consultation as well as medical analysis, a holistic multi-pronged approach by a medical practitioner will be used. This will involve advice with regards to nutrition, exercise, supplements as well as use of bio-identical (natural) hormone therapy. The therapy can be administered via oral, topical or needleless (pain-free) injection. These treatments will be customized based on individual needs and requirements. With a good treatment programme and monitoring, the hormonal imbalance can be reversed and the harmony of good health and beauty can be achieved.

Finally scientific revolution has proved its worth in both treatment and prevention.

Live Well. Live Happy.
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